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From the 4/23/2021 release of VAERS data:

This is VAERS ID 767887



Case Details

VAERS ID: 767887 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2018-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Depressed level of consciousness, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID0095075131808IDN010115

Write-up: Information has been received from a business partner representative referring to a 10 year old female patient. The patient''s concurrent condition, medical history and concomitant medication were unknown. On an unknown date (reported as 08-AUG-????) the patient was vaccinated with GARDASIL (dose, route, batch/ lot # and expiration date were unknown) for prophylaxis. On an unknown date (reported as 08-AUG-????), the patient experienced vomiting, decrease of consciousness and got hospitalized. On an unknown date (reported as 14-AUG-????), the patient passed away. The cause of death was not provided. It was unknown if autopsy was performed. The causality assessment was not provided by reporter. Reported Cause(s) of Death: unknown cause of death.


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